Department of Surgery, Duke University Medical Center, Durham, NC 27708, USA.
J Am Coll Surg. 2011 Apr;212(4):522-9; discussion 529-31. doi: 10.1016/j.jamcollsurg.2010.12.038.
Surgeon-performed cervical ultrasound (SUS) and 99Tc-sestamibi scanning (MIBI) are both useful in patients with primary hyperparathyroidism (PHPT). We sought to determine the relative contributions of SUS and MIBI to accurately predict adenoma location.
We performed a database review of 516 patients undergoing surgery for PHPT between 2001 and 2010. SUS was performed by 1 of 3 endocrine surgeons. MIBI used 2-hour delayed anterior planar and single-photon emission computerized tomography images. Directed parathyroidectomy was performed with extent of surgery governed by intraoperative parathyroid hormone decline of 50%.
SUS accurately localized adenomas in 87% of patients (342/392), and MIBI correctly identified their locations in 76%, 383/503 (p < 0.001). In patients who underwent SUS first, MIBI provided no additional information in 92% (144/156). In patients who underwent MIBI first, 82% of the time (176/214) SUS was unnecessary (p = 0.015). In 32 patients SUS was falsely negative. The reason for these included gland location in either the deep tracheoesophageal groove (n = 9) or the thyrothymic ligament below the clavicle (n = 5), concurrent thyroid goiter (n = 4), or thyroid cancer (n = 1). In 13 cases, the adenoma was located in a normal ultrasound-accessible location but was missed by the preoperative exam. In the 32 ultrasound false-negative cases, MIBI scans were positive in 21 (66%). Of the 516 patients, 7.6% had multigland disease. Persistent disease occurred in 4 patients (1%) and recurrent disease occurred in 6 (1.2%).
When performed by experienced surgeons, SUS is more accurate than MIBI for predicting the location of abnormal parathyroids in PHPT patients. For patients facing first-time surgery for PHPT, we now reserve MIBI for patients with unclear or negative SUS.
外科医生进行的颈部超声（SUS）和 99Tc-甲氧基异丁基异腈扫描（MIBI）在原发性甲状旁腺功能亢进症（PHPT）患者中均有用。我们旨在确定 SUS 和 MIBI 对准确预测腺瘤位置的相对贡献。
我们对 2001 年至 2010 年间接受 PHPT 手术的 516 名患者进行了数据库回顾。SUS 由 3 名内分泌外科医生中的 1 名进行。MIBI 使用 2 小时延迟的前平面和单光子发射计算机化断层扫描图像。甲状旁腺切除术的范围由术中甲状旁腺激素下降 50%决定。
SUS 准确定位了 87%的患者（342/392）的腺瘤，而 MIBI 正确识别了 76%的患者（383/503）的位置（p<0.001）。在首先进行 SUS 的患者中，MIBI 未提供额外信息的比例为 92%（144/156）。在首先进行 MIBI 的患者中，82%的情况下（176/214）不需要 SUS（p=0.015）。在 32 名患者中，SUS 呈假阴性。这些原因包括腺体位于深部气管食管沟（n=9）或锁骨下甲状腺胸腺韧带（n=5）、并发甲状腺肿（n=4）或甲状腺癌（n=1）。在 13 例中，腺瘤位于超声可及的正常位置，但术前检查漏诊。在 32 例超声假阴性病例中，MIBI 扫描阳性率为 66%（21/32）。在 516 名患者中，7.6%有多腺体疾病。4 名患者（1%）发生持续性疾病，6 名患者（1.2%）发生复发性疾病。
当由经验丰富的外科医生进行时，SUS 比 MIBI 更准确地预测 PHPT 患者异常甲状旁腺的位置。对于首次接受 PHPT 手术的患者，我们现在将 MIBI 保留用于 SUS 不明确或阴性的患者。
